Why ovarian cancer incidence is up

Reproductive Shifts and Ovarian Cancer Risk in Women Aged 40 Years or Older

https://tinyurl.com/58neb6xd

For many years the incidence of ovarian cancer was seen to be decreasing, this was thought mostly to be due to hormonal contraception, which results in fewer lifetime menstrual cycles. Now in some populations, especially South-East Asia the incidence is rising.

This population survey of women in South Korea looks at why this is occurring. The study group includes all women aged 40 or more who underwent health screening in 2009 and were followed until diagnosis of ovarian cancer. Those women who had delivered two or more children and breast-fed had a lower risk of ovarian cancer as did women with a history of more than one year’s use of hormonal contraception.

In the last 50 years there has been a dramatic decline in fertility for women in South Korea from a rate of more than four to less than one lifetime births. Also, the menarche is happening earlier. These two factors have the potential to markedly increase the number of lifetime menstrual cycles and warrant close attention to prevent yet more increase in the number of women who develop ovarian cancer.

Cancer after IVF

Cancer Incidence in Women After Medically Assisted Reproduction

https://tinyurl.com/y5pjhxy9

A feature of medical care in the 21st Century has been the rise of Medically Assisted Reproduction (MAR). About one in six couples seek such intervention. This population study of more than 400,000 women in Australia looks at the incidence of cancer following MAR.

The data included MAR treatments, pregnancies, subsequent cancers, and deaths. All the information was obtained from the Medicare Benefits Schedule and the Pharmaceutical Benefits Schedule during the period 1991-2018.

Results from the study showed small increases in the incidence of ovarian, uterine and breast cancer, with a slight increase in the incidence of melanoma. Some cancers were less likely after MAR, these include pancreatic, renal, lung, and myeloid leukaemia. The authors note than the increases are small with overall increase of about 16/100,000 pa. There are some limiting factors in the conclusions in that there is little data about the nature of any malignant change and that the follow-up period is short. Some of the increase in cancers may be due to pre-existing conditions such as endometriosis or PCOS.

Why is chemo so nauseous?

Novel therapies for nausea and vomiting in advanced illness and supportive cancer care

https://tinyurl.com/52nu5m5z

For cancer patients on chemo one of the most distressing adverse effects is nausea and vomiting. About 50% of them experience severe nausea. Some chemo, notably the platinum drugs are even more likely to result in severe nausea, with all patients being affected to some degree. Up to 20% of them will either cease or have their treatment modified because of it. Despite this being so common the cause is little understood.

It is thought that the emetic effect of chemo is due to altered gastric and bowel transit, increased mucosal sensitivity, altered gut-brain communication or psychiatric anxiety, Support for the latter cause comes from the effectiveness of antipsychotic medication such as haloperidol in managing nausea for some patients, these drugs act to block neurotransmitter receptors.

To counter this it is now standard therapy to treat patients prophylactically with Ondansetron being the most used drug, increasingly quadruple therapy, which adds receptor blockers with steroids and anti-psychotic treatment, is employed.

Other forms of treatment are in development. These include Blonanserin an antipsychotic used trans dermally for nausea and Mirtazapine an anti-depressant. In acute presentations inhaling fumes from alcohol infused prep wipes has been shown in controlled trials to be effective and reduce drug costs, this mostly reduces nausea, less so vomiting.

Class actions, who wins?

Australian women file writ against Johnson & Johnson over link between talcum powder causing mesothelioma and cancer

https://tinyurl.com/vzvvj9yh

Class actions or contingent litigation are increasingly common and have become important sources of income for lawyers and third-party funders. This no win, no fee legal process groups together individuals who believe they have been adversely affected by the actions of big corporate business. One of the latest in Australia involves an attempt to obtain financial compensation for cancer caused allegedly by talcum powder. 1300 women have registered an interest in a case to be heard in the Victorian Supreme Court.

Defendants in the writ are the multinational Johnson and Johnson who have been subject to many similar suits in the US. They dispute the link betewen talc and cancer and deny that their product might be contaminated with asbestos, which is a well proven cause  of mesothelioma. In a recent statement the World Health Organisation has classified talc as probably carcinogenic.

The legal process in the US has been lengthy and remains incomplete. No doubt any case in Australia would be similar. Many of the women will not understand the legal delay and judging by previous similar cases, could well be disappointed with the result.